62 day performance john wayman north cumbria. 62 day performance 2012 (upper gi)
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62 day performance
John WaymanNorth Cumbria
62 Day performance 2012 (Upper GI)
Upper GI Cancer pathway
Upper GI Cancer pathway
14 days14 days
Upper GI Cancer pathway
14 days14 days
Upper GI Cancer pathway
14 days14 days 14 days14 days
Upper GI Cancer pathway
14 days14 days 14 days14 days 7 days7 days
Upper GI Cancer pathway
14 days14 days 14 days14 days 7 days7 days
Upper GI Cancer pathway
14 days14 days 14 days14 days 7 days7 days
Upper GI Cancer pathway
14 days14 days 14 days14 days 7 days7 days 7 days7 days
“Further Investigations”
“Further Investigations”
<20days?
Why are we missing 62 day target?
Nationally• Long, multi-step pathway
Diminishing performance of steps:
“Step” “Pathway”1 95% 95%2 95% 90%3 95% 85%4 95% 80%
Locally• Limited capacity
– CT– USS– MRI– Bronchoscopy – Endoscopy
• Reliance on other providers– EUS– C-PEX– PET CT– EMR
Saving time
• Solutions– >95% OGD within 7 days– >95% CT within 7 days– Investigate in parallel– Provide EUS and PET in
house– Staging Admission– Remove MDT re-visits
from pathway (Investigated to Protocol)
• Risks– Capacity?
– Capacity?– Over investigation– Cost of equipment and
expertise– Capacity?– Exclude specialist
interpretation of results and insufficient CNS support to co-ordinate
Suggestions?• Agree protocols for local MDT’s for
– PET/Bone scan – EUS – Neck USS– Bronchoscopy– C-PEX
• Discuss at specialist MDT only after all investigation complete (or a result which “stops” the curative pathway)
• Combine investigations – EUS + Neck USS + C-PEX/Anaesthetic assessment
• Other Suggestion??